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Children's Hospital Wards (Visits)

Volume 498: debated on Wednesday 26 March 1952

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1.6 p.m.

After a long time I have the honour of raising on the Adjournment a matter which is of great concern to all who are interested in child welfare in this country, namely, the question of visiting in children's wards in hospitals.

I do not want in my speech to tread on anybody's corns, and I realise that this is a matter which must be approached with a sense of responsibility. I am not asking, nor would I ever think of asking, the Ministry to direct in any way hospital boards or hospital management committees in this matter, but the Parliamentary Secretary to the Ministry of Health must not forget that they are not elected bodies. Therefore, public opinion does not have on them the effect that it has on elected bodies. It is only through the suggestions or influence of the Ministry itself that pressure of any sort can be brought to bear on them—although I do not suggest for a moment that the pressure should be strong.

There is a number of hospitals which have experimented with daily visiting in children's wards over a long period, although the majority of hospitals have not. That is the situation at the moment. It is interesting to note that, in my constituency, one reason for this experiment was that the hospital authorities had seen mothers standing on the saddles of their bicycles and peeping over the wall in the hope of getting a glimpse of their children. This experiment has continued for several years, and it is not the only hospital where it has been tried.

There are two main objections to daily visiting. One is infection and the other is disturbance. Let me speak about infection first. The arguments on this ground have not been sustained, for several reasons. One is that there is daily visiting in private wards without any detrimental effects. Another is that there are going into and out of the public wards laboratory assistants, cleaners, students, and of course the nurses themselves. The third and most important is that in 1945 the British Paediatric Association instituted an investigation and failed to find that there was any correlation between visiting and cross-infection. The matron of Worthing hospital wrote in the "Nursing Times" recently that in not one single instance had infection been traced to visitors, yet, as I say, we have had this experiment for a considerable time In Worthing.

It is the objection on the grounds of disturbance that is more important. The question is whether or not this visiting daily has an adverse effect on the child, and whether, from this point of view, the visiting should be daily or once a week, and that is the matter about which I want to speak most. The argument in favour of the weekly visiting is that the child is more placid, more content and less emotionally upset than if it is visited daily by its mother. I assure the hon. Lady that those who say that come from hospitals that have never tried it, and who do not see the results on the children. The results are not apparent until the children have left the hospital. They have not seen the emotional, frozen aspect that lasts very often for nearly a week, the almost complete breakdown, the tearful clinging, the nightmares, the tantrums and the wetting of beds, all clearly the direct result of repression and frustration.

I know of a case of a child to whose mind irreparable damage has been done I do not believe she will ever recover from it. I know of another child who had an accident and went into hospital, where she was very restless. The nurses could not understand it and asked: "Is she always like this?" It was due to repression of the fear that the accident which caused her entry into hospital had been her own fault and after it had been explained that it was not, she became a perfectly peaceful, normal child. That would have continued if the parent had not been allowed to visit her on the next day. Sometimes damage is done by naughty children. I know of an odious boy who said to the child in the next cot: "You are never going to see your mother again. She will not come back to see you." That is absolutely true, and I know the effect upon a child's mind of being told those things.

These are isolated instances, and I know that one swallow does not make a drink, but they are indicative of what goes on in many children's wards where daily visiting is not practised. Let us remember one very serious point. A day in the life of a very young child, say of three years old, is an age. If that is true of a whole long day, a week is quite incomprehensible.

There are various aspects of this matter. Some hospitals do one thing and some do another. Where there has been 100 per cent. success, there has been the rule that the mothers must be kept fully occupied during the time they are visiting. Otherwise the time palls, and the parents begin to look at their watches. It is most important that they should be engaged in doing the normal tasks that they would perform were the children at home. They should try not to break the continuity, but should be doing such things as changing the nappy, reading, prayers, tucking the child up in bed or, as is done in some hospitals, staying with the child until it has gone to sleep. Furthermore, it has been arranged that a doctor shall be there at visiting hours so that he can speak personally with the parents. The introduction of food into the hospital is forbidden and there are other rules and regulations.

This brings me to a point which I wish to stress very strongly. In the final analysis, the sister in charge of the children's ward must have a sanction to prohibit all visits from any parent whom she may think undesirable for any reason of undesirability. We know that there are undesirable parents. There are children who do not want to see their parents, and who are apt to say: "How soon is mummy going?" That is another aspect of the question. The sister in charge of the ward must have the final say in this matter. I am wholeheartedly behind that idea, and if it is carried out in a humanitarian way it leads to no difficulty or trouble.

It is idle to pretend that there are no difficulties. This is not a Utopian scheme. Perhaps a parent cannot get to the hospital. The Red Cross provide visitors for parents in those circumstances, and are willing to see a child every day. They have done that in the past. Also, parents who come to other children may know personally parents who cannot visit, and they can carry out the visiting function. This difficulty is not insuperable because it has been overcome. The basic principle underlying this experiment, which is being carried out in various hospitals, is to continue the mother-child relationship, which is so essential to the mental welfare of a child, and not to destroy that sense of security and protection for which children crave, whether or not they show it.

In my view it is vital for the mental welfare of the young children in the future. Hospitals who have tried this have found it has been entirely successful. Dr. Parry, writing in the "Sussex Daily News "on 2nd December, 1949, says:
"Where it has been tried it has been found such a brilliant success that it is difficult to understand the opposition to it."
I should like to stress the word "brilliant."

I feel that here we are firing a shot against juvenile delinquency. That is one of the matters which exercises the minds of all of us very much indeed. I wish to quote a case in which 44 juvenile delinquents were examined and it was discovered that the great majority of them were suffering from early separation from their parents, due in a large number of cases to entry into hospital.

There is one vitally important aspect which was stressed by Professor Moncrieff, who is at the Great Ormond Street Hospital for Sick Children in London where this experiment is in operation. The preparation of the children by the parents for the "adventure" of entering hospital is tremendously important. It is of the greatest value to get the children into the right frame of mind when they are about to enter hospital, so that they know what to expect. I stress that point. I am not asking for a sudden swing. I want to see hospitals try this scheme and to increase its extent as they go along. I know that the Ministry sent out a circular two and a half years ago encouraging this system, but, as far as I can see, that circular has not yet had much effect.

I ask the hon. Lady whether she will do this. I assure her that I would do it if I were in her shoes. I ask her to circularise the regional boards and ask them for evidence from the hospitals which are trying this experiment; and to request that this evidence should be sent to her Department and have it consolidated into a concise statement. All I want her to do is to send that evidence to all the hospitals which do not carry out this system. I do not want any coersion of any sort, but I think that if enlightened hospitals see that evidence they will change their minds. I ask her to add a fairly strong recommendation—rather stronger than that in the circular of two and a half years ago—that this should at least be tried as an experiment.

1.17 p.m.

I hope that the Parliamentary Secretary will accept the request made by the hon. and gallant Gentleman the Member for Worthing (Brigadier Prior-Palmer). I am sure that he has not exaggerated a single aspect of the matter. I am satisfied that granting what he has requested is the least we could do.

I urge the Parliamentary Secretary to remember that with all human beings the severing of the umbilical cord when we are born is something that happens only to the physical cord. The emotional, mental and spiritual cords that link us with our mothers when we are young wither away only as time goes on and we gain our strength. Every moment of time is an eternity to each and every child if it is taken away from the safety of its own background. What is being asked for is wholly right, and if it is not acceded to I shall feel that the House is not doing its duty.

1.18 p.m.

The Parliamentary Secretary to the Ministry of Health
(Miss Patricia Hornsby-Smith)

I should like to thank my hon. and gallant Friend the Member for Worthing (Brigadier Prior-Palmer) for the very fair manner in which he has presented this most human problem. I assure him that it has the fullest sympathy of our Ministry. As he said, the practice varies in hospitals from complete prohibition on visiting to daily visiting in children's wards. He has put very fairly the arguments, which we accept, in favour of visiting. The psychological disturbance which he mentioned, particularly in the toddler stage when children through some accident or other illness, are separated for the first time from their parents, may be both serious and long lasting.

There is another side, and that is the strain on the parents who suddenly have removed from their care the young child whom they regard so dearly and whom they feel most concerned about. There is also the disturbance to children when visits are prohibited, especially when the period may run into weeks, and on return the parents find that there has been a natural development of the possessive attitude on the part of the nursing staff.

At the same time, we recognise the arguments against visiting. It is said on behalf of those hospitals which make this prohibition that it upsets the children, that it may spread infection, that it wastes the time of the staff, and that it upsets the hospital routine. We do not think that the evidence that we have seen, especially that concerning the last two considerations, can be regarded as decisive.

In the experience of those hospitals which have undertaken to allow visiting, we believe that when the children are visited it helps if the parents can stay, if it is an evening visit, until the children are asleep. The parents will return next day, and after the initial visit the child will get used to seeing its parents return. I agree with the remarks quoted by my hon. and gallant Friend, referring to the report of the British Pediatric Association who said that from all the evidence that they have collected they could find no correlation between visiting and cross-infection. I agree with him, for example, when he says that a parent with an obviously severe or streaming cold should not be allowed permission to enter if the sister thinks that such a visit is not in the best interests of the child.

We are aware of the most interesting and successful experiments carried out in the Sussex Hospital. There the nursing and the medical staff were reluctantly persuaded to try this experiment. As my hon. and gallant Friend said, they have been completely converted, and it is largely on the persuasion of the medical and nursing staff that this new principle has been accepted by other hospitals in the same group.

There has been a full investigation and report in the "British Medical Journal," in respect of the Great Ormond Street Hospital for Children, which is renowned nationally and internationally for its work in the care of sick children. There they have expanded the method to a visit each evening. They have done everything in their power to maintain a really human touch whereby the mother visits each evening, helps in giving the child its supper, may read to it, clean its teeth and may even wait until it goes to sleep before she leaves. The experiment has been wholly successful and is generally accepted by the hospital. They have even made provision for substitutes where the mother cannot attend. The mother of one child will look after the toddler of a mother who cannot attend on that evening. We believe that the experiment has been of great value and that it has proved the greatest success.

As my hon. and gallant Friend said, the advice of the Central Health Service Council was sought by the Minister in 1949. We have been told that they found an unjustifiably wide variation in the practice in different hospitals, and they recommended that hospitals should be asked to adopt a less rigid attitude in this matter. At the same time, we were anxious—and I am glad that my hon. and gallant Friend agrees with us on this point—that there should be no attempt widely to impose or to formulate precise rules which must be carried out by the separate hospitals. We believed that the most we should do was to advise the hospital authorities, under adequate safeguards, to allow parents or guardians to visit children with reasonable frequency and, if necessary, by appointment.

That recommendation was circulated by the Minister to the hospital management committees and to the boards of governors, and they were asked to review the systems in operation within their own hospitals. I have no information as to the extent of the operation of that circular, but I do not think that it has been quite as unsuccessful as the hon. and gallant Gentleman suggested, in that no hospital has amended its regulations since its circulation.

I think that I can give the hon. and gallant Gentleman better news than that. Certainly some relaxation has been allowed in several hospitals in the country. At the same time, we believe that the advice given by the Central Council, and accepted by the Ministry, is one in the best interests of the child and the mother. We believe that it is very advisable that hospitals which still prohibit this method should take advice and guidance from those who have tried it, and themselves make a similar experiment to see whether they cannot relax their rules and allow this visiting to their children's wards.

It is 2½ years, as the hon. and gallant Gentleman pointed out, since this recommendation was sent out. I should like to inform him now that we propose to follow up the recommendation by calling on the hospital authorities to furnish a report to the Ministry on what steps they are taking, what methods they are using, and to what extent they are implementing the recommendation.

Question put, and agreed to.

Adjourned accordingly at Twenty-seven Minutes past One o'Clock p.m., 27th March, 1952.